NCLEX-PN-style practice questions (LPN/LVN): cram pack

A dying patient is no longer drinking and breathes through the mouth. What mouth care is most appropriate?

1. AGive large drinks of water every hour
2. BClean the mouth only once a day with a hard toothbrush
3. CAvoid mouth care so the patient is not disturbed
4. DKeep the mouth and lips moist with frequent gentle care

On the morning of surgery, a patient who signed the consent form says they do not understand what the operation involves. What should the nurse do?

1. ASend the patient to theatre, as the form is already signed
2. BInform the surgeon so consent can be discussed again before surgery
3. CReassure the patient that signing the form is enough for consent to be valid
4. DExplain the operation's risks themselves and go ahead

Which practice reduces back strain when a nurse moves a patient or heavy object?

1. AStand with the feet close together for balance
2. BBend at the waist and keep both knees straight
3. CKeep the load close to the body and avoid twisting
4. DHold the load at arm’s length to keep it steady

A nurse teaches parents about using an infant car seat. Which statement shows a need for further teaching?

1. A“We will put the rear-facing seat in the front so we can see the baby.”
2. B“We will use the car seat for every trip, even short ones.”
3. C“We will install the seat in the back seat, facing the rear.”
4. D“We will make sure the harness straps are snug against the baby’s chest.”

A nursing assistant refuses a delegated task, saying they have not been trained to do it. What is the best response from the nurse?

1. ATell the assistant it is in the job description and must be done
2. BLeave the task for the next shift, when someone trained is on
3. CThank the assistant, make sure the task is done safely and arrange training
4. DReport the assistant to the manager for refusing a task

A patient with SIADH has a serum sodium of 120 mEq/L and is newly confused. Which nursing action has priority?

1. AHelping the patient to walk in the corridor alone
2. BSeizure precautions and close neurological checks
3. CTeaching the patient about a low-sodium diet at home
4. DEncouraging the patient to drink plenty of water

A spontaneously breathing patient is critically ill and hypoxic. Which oxygen delivery gives the highest concentration?

1. ASimple face mask at 5 L/min with the patient sitting up
2. BNasal cannula at 2 L/min
3. CVenturi mask set to 24%
4. DNon-rebreathe mask with reservoir bag at 15 L/min

A patient with hyperkalaemia is given IV insulin with glucose. What is the purpose, and what must be monitored?

1. ATo treat hidden diabetes; HbA1c must be checked daily
2. BTo shift potassium into cells; blood glucose must be monitored for hypoglycaemia
3. CTo remove potassium from the body; urine output must be stopped for a time
4. DTo protect the heart muscle directly; the patient must be kept nil by mouth

How should a patient collect a clean-catch midstream urine sample?

1. AFill the cup completely, then add tap water if there is not enough
2. BClean the area, start voiding into the toilet, then catch the middle part
3. CCollect the very first urine of the stream directly in the sterile cup
4. DCollect urine from the toilet bowl after voiding into the toilet

A patient with heart failure has a BNP that was very high on admission and is now falling after diuretic treatment. What does this most likely show?

1. AThat the diuretic must be stopped at once
2. BWorsening heart failure that needs more fluids
3. CNew kidney failure caused by the diuretic
4. DLess stretch on the heart, consistent with improvement

A patient starting niacin (nicotinic acid) complains of flushing and warmth after doses. Which advice may reduce this?

1. ADouble the dose to build tolerance faster
2. BTake aspirin 30 minutes before the niacin, if the prescriber agrees
3. CTake it on an empty stomach in a hot bath
4. DTake the niacin with a hot drink so that it dissolves and acts faster

The thalidomide disaster of the late 1950s and early 1960s is best known for which effect, and what did it lead to?

1. AHeart attacks in older adults; the start of generic medicines
2. BLiver failure in adults; the ban of all sedatives
3. CDeafness in children; the end of animal testing
4. DSevere limb defects in babies; stricter drug testing and regulation

Which laboratory test is used to adjust an unfractionated heparin infusion?

1. AINR (international normalised ratio)
2. BaPTT (or anti-Xa level)
3. CD-dimer level
4. DSerum fibrinogen level

A patient with small-cell lung cancer becomes confused. Sodium is 122 mmol/L (122 mEq/L) with concentrated urine, and there are no signs of dehydration. What is the most likely cause?

1. AExcess salt in the diet over several weeks
2. BSyndrome of inappropriate ADH secretion
3. CSevere dehydration from poor oral intake
4. DCranial diabetes insipidus from brain metastases

For which patient would the nurse question an order for pioglitazone?

1. AA patient with hypothyroidism
2. BA patient with heart failure
3. CA patient with an allergy to latex
4. DA patient with asthma

A patient on long-term high-dose prednisolone is three days after bowel surgery. They report only mild abdominal pain, but the heart rate has risen to 115/min and the temperature is 37.4 °C. Why should the nurse be especially concerned?

1. AThe mild pain shows that the bowel is healing as expected
2. BSteroids can mask fever, pain and peritonism, hiding complications
3. CSteroids cause tachycardia in all patients, so no action is needed
4. DSteroids protect against infection, so sepsis is very unlikely

Which advice may help reduce the risk of a parastomal hernia after stoma surgery?

1. AKeep the stoma bag as full as possible
2. BStrain hard on the toilet each day to strengthen the abdominal muscles
3. CAvoid heavy lifting early on and use support garments as advised
4. DDo intensive sit-ups from the first week

On day 6 after abdominal surgery, a patient says something "gave way" when coughing, and bowel is visible through the wound. What should the nurse do immediately?

1. ALeave the wound uncovered and sit the patient fully upright in bed
2. BGive the patient a light meal to calm them while waiting for the team
3. CPush the bowel back gently and tape the wound edges together firmly
4. DCover with saline-soaked sterile dressings, bend the knees, call the surgeon

A woman with hypothyroidism becomes pregnant. What usually happens to her levothyroxine needs?

1. AShe switches to iodine tablets instead
2. BThey usually rise, so levels are checked early
3. CThey decrease to zero, so she stops the drug
4. DThey stay the same, so no monitoring is needed

A breastfeeding mother has a hard, tender lump in one breast without fever. She feels well. What is the most likely cause and the best advice?

1. AMastitis; stop feeding from that breast
2. BA blocked duct; keep feeding and vary positions
3. CBreast cancer; stop breastfeeding at once
4. DA breast abscess; stop breastfeeding completely

How should oral rehydration solution be given to a child with mild to moderate dehydration who is vomiting?

1. AMixed with fruit juice to improve the taste
2. BOnly after the vomiting has stopped for 24 hours, to avoid further losses
3. CIn small amounts, frequently, for example with a spoon or syringe
4. DAs one large drink every few hours

A 2-year-old is having a tonic–clonic seizure with a high fever. What should the nurse do first?

1. AProtect the child from injury, time the seizure and turn the child onto the side
2. BHold the child's limbs firmly to stop the movements and prevent injury from the jerking
3. CPut the child in a cool bath
4. DPut a spoon in the child's mouth to protect the tongue

Which nurse statement is most consistent with motivational interviewing?

1. A"What would be different for you if you drank less?"
2. B"You're an alcoholic, and you need to admit it."
3. C"If you don't stop drinking now, you'll die."
4. D"I've decided that you need to stop drinking completely."

A voluntary patient asks to leave the ward now. While talking, he says he plans to jump from a bridge on the way home. What should the nurse do?

1. AAsk him to promise that he will not jump, and then let him go home on his own
2. BTell him to go home now and come back tomorrow morning when he feels calmer and safer
3. CLet him leave, because voluntary patients can always go when they want
4. DStay with him and inform the team at once, so he can be urgently assessed under mental health law

Practice exercise (made-up values, not clinical guidance). A dose is charted at 14:15 (24-hour clock). Which entry is the same time on the 12-hour clock? Click it.

1. 11:15 PM
2. 24:15 PM
3. 32:15 AM
4. 42:15 PM

Practice exercise (made-up values, not clinical guidance). During a shift a patient takes 8 fl oz of juice, 2 cups of tea, 1½ tbsp of liquid supplement. Using the equivalents given, find the total oral intake V in mL.

A vial contains 500 mg of powder. The label says: add 4.6 mL of water for injection to give a total volume of 5 mL. The prescription is 60 mg. What volume V of the reconstituted solution do you give?

A patient weighs 173.8 lb. The prescription is 10 mg/kg as a single dose, and the stock contains 250 mg in 5 mL. Using 1 kg = 2.2 lb, what volume V do you give?

Infuse 1000 mL over 10 hours with a giving set of 60 gtt/mL. Find the drip rate R in drops per minute.

An infusion of 50 mg in 500 mL runs at 5 mL/h. How many micrograms per minute D does the patient receive?

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the fluid balance B = intake − output in mL (a negative answer means a net loss). Count ice chips as half their volume.

Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 10:30 at 120 mL/h. After 2 hours the rate is changed to 75 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.

Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 25/min, SpO₂ 99% on room air, blood pressure 136/82 mmHg, pulse 58/min, alert, temperature 37.0 °C. What is the NEWS2 total score?

Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 18/min, SpO₂ 98% on room air, blood pressure 118/70 mmHg, pulse 64/min, alert, temperature 39.2 °C. Which clinical risk group does the patient fall into? Click it.

1. 1low
2. 2low–medium
3. 3medium
4. 4high